Bottom Line:
Recurrence within 30 days occurred in two patients with 027 and two patients with 014/020 (P=0.6).Leukocytosis and fever were more prominent with 027 than with 014/020 and 106/174 (P=0.04 for both parameters), although the degree of nausea/vomiting did not differ between the three groups (P=0.3).Although these data provide a baseline assessment of outcomes to aid in the design of future studies, the diversity of C. difficile ribotypes within the population must be considered, and additional work with other ribotypes may further explain the association with these outcomes.

Background: Clostridium difficile infection ranges from mild to severe prolonged diarrhea with systemic symptoms. Previous studies have assessed the correlation of some disease severity parameters to C. difficile ribotypes. However, certain clinical parameters of interest have not yet been evaluated.

Aim: We conducted an exploratory study to evaluate the correlation of C. difficile ribotypes to parameters not assessed previously, notably days to diarrhea resolution (in terms of days to formed stools and days to less than three stools per day), length of hospital stay, 30-day recurrence rates, and 30-day readmission rates. Additional severity parameters evaluated include leukocytosis, serum creatinine, fever, and nausea/vomiting.

Methods: Polymerase chain reaction ribotyping was performed on C. difficile isolates from baseline stool samples of 29 patients. A retrospective chart review was conducted to assess the parameters of interest.

Results: The most common ribotypes were 027 (38%), 014/020 (21%), and 106/174 (21%). Numerically, 027 ribotype patients required more days to less than three stools per day versus 014/020 and 106/174 ribotype patients (P=0.2). The three ribotypes were similar regarding time to formed stools, duration of hospitalization, and 30-day readmission rate (P=0.2, 0.6, and 0.8, respectively). Recurrence within 30 days occurred in two patients with 027 and two patients with 014/020 (P=0.6). Leukocytosis and fever were more prominent with 027 than with 014/020 and 106/174 (P=0.04 for both parameters), although the degree of nausea/vomiting did not differ between the three groups (P=0.3). A serum creatinine level ≥1.5 times the premorbid level was seen in only three patients, each infected with a different ribotype.

Conclusion: Although these data provide a baseline assessment of outcomes to aid in the design of future studies, the diversity of C. difficile ribotypes within the population must be considered, and additional work with other ribotypes may further explain the association with these outcomes.

f1-idr-9-143: Time taken for patients with Clostridium difficile polymerase chain reaction ribotypes 027, 014/020, and 106/174 to achieve less than three stools per day (A), formed stools (B), and hospital discharge (C).Notes:P-values were derived from log-rank test of Kaplan–Meier test.

Mentions:
The C. difficile PCR ribotypes identified and their corresponding measures of severity are shown in Table 1. Although patients infected with 106/174 ribotype had numerically shorter duration to resolution of diarrhea in terms of achieving less than three stools per day and formed stools than patients infected with 027 and 014/020 ribotypes who had approximately double the duration, these differences were not statistically significant (P=0.9 and P=0.4, respectively) (Figure 1A and B). Likewise, the three groups did not differ with regard to length of stay until hospital discharge, as admission times in all groups ranged from as short as 1 day to as long as 13 days (P=0.6) (Figure 1C). Five patients of the total cohort developed CDI recurrence within 30 days of study enrollment (two with 027 ribotype, two with 014/020 ribotype, and one patient with 053/163 ribotype). When the effect of ribotype on 30-day recurrence was compared between patients infected with 027 versus those infected with 014/020, no statistical difference was noted (P=0.6). When 30-day readmission was assessed in the three major groups, only three patients infected with 027 ribotype were admitted compared with one patient with 014/020 and one patient with 106/076 (P=0.8). In addition, one of the two patients infected with 001 ribotype and a patient from whom C. difficile was not isolated at baseline were readmitted within 30 days of treatment initiation.

f1-idr-9-143: Time taken for patients with Clostridium difficile polymerase chain reaction ribotypes 027, 014/020, and 106/174 to achieve less than three stools per day (A), formed stools (B), and hospital discharge (C).Notes:P-values were derived from log-rank test of Kaplan–Meier test.

Mentions:
The C. difficile PCR ribotypes identified and their corresponding measures of severity are shown in Table 1. Although patients infected with 106/174 ribotype had numerically shorter duration to resolution of diarrhea in terms of achieving less than three stools per day and formed stools than patients infected with 027 and 014/020 ribotypes who had approximately double the duration, these differences were not statistically significant (P=0.9 and P=0.4, respectively) (Figure 1A and B). Likewise, the three groups did not differ with regard to length of stay until hospital discharge, as admission times in all groups ranged from as short as 1 day to as long as 13 days (P=0.6) (Figure 1C). Five patients of the total cohort developed CDI recurrence within 30 days of study enrollment (two with 027 ribotype, two with 014/020 ribotype, and one patient with 053/163 ribotype). When the effect of ribotype on 30-day recurrence was compared between patients infected with 027 versus those infected with 014/020, no statistical difference was noted (P=0.6). When 30-day readmission was assessed in the three major groups, only three patients infected with 027 ribotype were admitted compared with one patient with 014/020 and one patient with 106/076 (P=0.8). In addition, one of the two patients infected with 001 ribotype and a patient from whom C. difficile was not isolated at baseline were readmitted within 30 days of treatment initiation.

Bottom Line:
Recurrence within 30 days occurred in two patients with 027 and two patients with 014/020 (P=0.6).Leukocytosis and fever were more prominent with 027 than with 014/020 and 106/174 (P=0.04 for both parameters), although the degree of nausea/vomiting did not differ between the three groups (P=0.3).Although these data provide a baseline assessment of outcomes to aid in the design of future studies, the diversity of C. difficile ribotypes within the population must be considered, and additional work with other ribotypes may further explain the association with these outcomes.

Background: Clostridium difficile infection ranges from mild to severe prolonged diarrhea with systemic symptoms. Previous studies have assessed the correlation of some disease severity parameters to C. difficile ribotypes. However, certain clinical parameters of interest have not yet been evaluated.

Aim: We conducted an exploratory study to evaluate the correlation of C. difficile ribotypes to parameters not assessed previously, notably days to diarrhea resolution (in terms of days to formed stools and days to less than three stools per day), length of hospital stay, 30-day recurrence rates, and 30-day readmission rates. Additional severity parameters evaluated include leukocytosis, serum creatinine, fever, and nausea/vomiting.

Methods: Polymerase chain reaction ribotyping was performed on C. difficile isolates from baseline stool samples of 29 patients. A retrospective chart review was conducted to assess the parameters of interest.

Results: The most common ribotypes were 027 (38%), 014/020 (21%), and 106/174 (21%). Numerically, 027 ribotype patients required more days to less than three stools per day versus 014/020 and 106/174 ribotype patients (P=0.2). The three ribotypes were similar regarding time to formed stools, duration of hospitalization, and 30-day readmission rate (P=0.2, 0.6, and 0.8, respectively). Recurrence within 30 days occurred in two patients with 027 and two patients with 014/020 (P=0.6). Leukocytosis and fever were more prominent with 027 than with 014/020 and 106/174 (P=0.04 for both parameters), although the degree of nausea/vomiting did not differ between the three groups (P=0.3). A serum creatinine level ≥1.5 times the premorbid level was seen in only three patients, each infected with a different ribotype.

Conclusion: Although these data provide a baseline assessment of outcomes to aid in the design of future studies, the diversity of C. difficile ribotypes within the population must be considered, and additional work with other ribotypes may further explain the association with these outcomes.